<%@ page contentType="text/html;charset=UTF-8" %>
<%@ include file="/common/taglibs.jsp" %>

<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<title>新增转院记录</title>
<%@ include file="/common/meta.jsp" %>
<link href="${ctx}/css/yui.css" type="text/css" rel="stylesheet"/>
<link href="${ctx}/css/style.css" type="text/css" rel="stylesheet"/>
<link href="${ctx}/js/validate/jquery.validate.css" type="text/css" rel="stylesheet"/>
<script src="${ctx}/js/validate/jquery.validate.js" type="text/javascript"></script>
<script src="${ctx}/js/validate/messages_cn.js" type="text/javascript"></script>
<script>
		$(document).ready(function() {
			$("#hospital").focus();
			$("#referralInputForm").validate({
				rules: {
					"entity.referralHospital":"required",
					"entity.referralReason"  : "required"
				},
				messages: {
					"entity.referralHospital": {
						required: "必填字段"
					},
					"entity.referralReason" : {
						required: "必填字段"
					}
				}
			});
		});
	</script>
</head>
<body>
<table width="850" class="noborder">
	<tr>
	<td align="left" ><div style="font-family:Arial;font-size:15px;font-weight:bold;font-style:normal">当前位置：校园诊所--转院管理--新增转院记录</div> </td>
	</tr>
</table>
<form id="referralInputForm" action="referral!save.action" method="post">
    <input type="hidden" name="id" value="${id}"/>
    <input type="hidden" name="clicicId" value="${clicicId}"/>
    <table width="850" class="noborder">
      <tr>   
             <td width="70"  align="left" valign="middle">学&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;号:</td>
	         <td width="250" align="left" valign="middle"><input disabled="disabled" value="${entity.clinic.patient.idNumber}" name="entity.clinic.patient.idNumber" size="20" /></td>
             <td width="210" align="right" valign="middle">姓&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;名:</td>
	         <td width="170" align="right" valign="middle"><input disabled="disabled" value="${entity.clinic.patient.name}" name="entity.clinic.patient.name" size="20" /></td>
	         <td></td>
      </tr>
      <tr>
             <td width="70"  align="left" valign="middle">班&nbsp;主&nbsp;任&nbsp;:</td>
	         <td width="250" align="left" valign="middle"><input disabled="disabled"  name="entity.clinic.patient.clazz.classCoordinator.name" value="${entity.clinic.patient.clazz.classCoordinator.name}" size="20" /> </td>
	         <td width="210" align="right" valign="middle">申请医生:</td>
	         <td width="170" align="right" valign="middle"><input disabled="disabled" value="${entity.clinic.doctor.name}" name="entity.clinic.doctor.name" size="20"/></td>
     		 <td></td>
      </tr>
      <tr>
             <td width="70"  align="left" valign="middle">转入医院:</td>
	         <td width="250" align="left" valign="middle"><input size="20"  id="hospital" name="entity.referralHospital" value="${entity.referralHospital}"/></td>
	         <td width="210" align="right" valign="middle"></td>
	         <td width="170" align="right" valign="middle"></td>
     		 <td></td>
      </tr>
      <tr>
        <td width="70" align="left" valign="middle">转院原因:</td>
        <td align="left" width="630" colspan="4" valign="middle"><s:textarea  name="entity.referralReason"  value="%{entity.referralReason}" theme="simple" cols="99" rows="5"/></td>
      </tr>
      <tr>
	     <td align="center" colspan="5" valign="middle"><s:submit type="button" theme="simple">保存</s:submit>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <s:reset type="button" onclick="history.back()" label="取消" theme="simple"></s:reset></td> 
      </tr>
    </table>
</form>
</body>
</html>